Restenosis after directional coronary atherectomy

Hinohara, Tomoaki; Robertson, Gregory; Selmon, Matthew R.; Vetter, James W.; Rowe, Michael H.; Braden, Lissa J.; McAuley, Bruce J.; Sheehan, Dennis J.; Simpson, John B.

doi:10.1016/0735-1097(92)90017-h

Cited by 72 publications

(12 citation statements)

References 17 publications

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“…Although additional passages decrease the plaque area in most stenoses, a large amount of residual plaque was still registered with IVUS after the final passage compared with the reference segment. The possible reasons for diminished plaque removal following DA passages support the hypothesis that removing fibroatheroma may alter plaque compliance which results in inadequate pressure of the cutter on the remaining plaque [35]. Other possibilities are the tendency of this device to orientate into the same direction once an initial cut is made, or torsion of the vessel caused by rotation of the relatively large device in narrowed vessels.…”

Section: Discussionmentioning

confidence: 80%

Evaluation of Directional Atherectomy Studied by Intravascular Ultrasound in Femoropopliteal Artery Stenosis

Tielbeek

Vroegindeweij

Gussenhoven

et al. 1997

Cardiovasc Intervent Radiol

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Section: Discussionmentioning

confidence: 80%

Evaluation of Directional Atherectomy Studied by Intravascular Ultrasound in Femoropopliteal Artery Stenosis

Tielbeek

Vroegindeweij

Gussenhoven

et al. 1997

Cardiovasc Intervent Radiol

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“…For optimal results DCA should attempt to leave no more than 15% residual diameter stenosis (18). Previous studies have shown that angiographically successful DCA leaves substantial plaque burden in place; thus there is need for both better imaging to control the quality of the results and subsequently for better debulking (16)(17)(18). Conversely, cuts into deep wall compartments such as media or adventitia are possible and DCA is known to carry a 0.5% risk of vessel perforation.…”

Section: Discussionmentioning

confidence: 99%

Impact of intravascular ultrasound guidance on directional coronary atherectomy

Koschyk¹,

Nienaber²,

Schaps³

et al. 2000

Z Kardiol

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In contrast to the luminogram of coronary angiography, intravascular ultrasound (IVUS) has proven to accurately assess both coronary lumen and vessel morphology due to its 360 degrees imaging capacity. Directional coronary atherectomy (DCA) improves the coronary lumen by removing plaque mass rather than stretching the vessel and compressing the plaque as with conventional percutaneous transluminal coronary angioplasty. In an attempt to optimize the procedural result of DCA we prospectively investigated the impact of IVUS guidance in a head to head comparison to on-line quantitative coronary angiography (QCA) on the result of DCA. In 16 consecutive patients IVUS demonstrated significant residual plaque mass after DCA irrespective of a satisfactory angiographic result. After a mean of 9 +/- 2 cuts luminal improvement was obtained with an area stenosis by angiography of 39 +/- 17% and by IVUS of 50 +/- 10% (p < 0.05), a diameter stenosis by angiography of 23 +/- 10% and IVUS of 35 +/- 14% (p < 0.05) and finally a minimal lumen diameter (MLD) by angiography of 2.9 +/- 0.5 mm and by IVUS of 2.3 +/- 0.5 mm (p < 0.005). After both on-line QCA and IVUS measurements a second series of 7 +/- 2 cuts were initiated to debulk more atheroma and improve stenosis dimensions. After additional cuts IVUS revealed further luminal improvement with an area stenosis by angiography of 25 +/- 16% and IVUS of 21 +/- 18% (n.s.), a diameter stenosis by angiography of 16 +/- 11% and by IVUS of 13 +/- 19% (n.s.) and finally a MLD by angiography of 3.1 +/- 0.5 mm and by IVUS of 2.8 +/- 0.3 mm (p < 0.05). Intraprocedural use of IVUS is superior to on-line QCA to assess the immediate result of DCA. IVUS-guided DCA results in more effective atheroma debulking than luminographic evaluation. Results of larger follow-up studies are needed to substantiate the intraprocedural advantage of IVUS with DCA.

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“…Directional coronary atherectomy (DCA) has been introduced as an interventional method that achieves lumen gain by removing plaque material from coronary lesions [39][40][41]. However, studies have failed to prove that DCA is more efficient than conventional PTCA in preventing late restenosis [42][43][44][45]. IVUS has been used to visualize the extent of plaque removal [46] and to assess the late outcome of DCA [47,48].…”

Section: The Role Of Ivus In Cardiac Interventionsmentioning

confidence: 99%

Use of Intravascular Ultrasound in Clinical Trials

Kuecherer¹

2002

Heart Drug

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Intravascular ultrasound (IVUS) permits detailed, high-resolution tomographic imaging of coronary architecture and enables the characterization of atherosclerotic lesions and plaque distribution. This unique value of IVUS easily explains and justifies why IVUS has found easy access to the clinical repertoire of a standard catheterization laboratory. Despite this fact, the contribution of IVUS findings relative to the total number of procedures performed in clinical catheterization laboratories can be considered small, and IVUS is seen primarily as an optional tool accompanying diagnostic or interventional procedures and as a mandatory tool mostly in angiographically ambiguous ostial or bifurcational lesions. In clinical trials, IVUS is used to assess changes that occur in vascular dimensions (remodeling) and plaque distribution during the disease process, during percutaneous interventions and at follow-up. One of the unique features of IVUS is that it is the only method to study remodeling in vivo. A standard image acquisition protocol is commonly applied to ensure premium quality of images and quantitative data. Motorized pullback devices are necessary to obtain reproducible length and volumetric measurements and provide uniform image acquisition. Ultrasound images are analyzed using manual tracing of acoustic interfaces. Since manual tracing is subjective, objective methods are currently being developed to minimize observer involvement. Fully automated segmentation of luminal and medial-adventitial boundaries has recently been demonstrated, but is still regarded as an experimental method. In the design of stent trials, IVUS is partially used to evaluate the effects of stent deployment on patient outcome. IVUS-guided stent implantation has been shown to result in less frequent clinically driven target vessel revascularization than angiographic guidance alone, although mortality and infarct rate are not affected. A current focus is on serial observation of plaque burden in lipid-lowering therapy.

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Restenosis after directional coronary atherectomy

Abstract: Restenosis remains a limitation of directional coronary atherectomy. A subset of patients with larger vessels, shorter lesions or lesions treated with a larger (7F) device may have a more favorable outcome.

Cited by 72 publications

References 17 publications

Evaluation of Directional Atherectomy Studied by Intravascular Ultrasound in Femoropopliteal Artery Stenosis

Evaluation of Directional Atherectomy Studied by Intravascular Ultrasound in Femoropopliteal Artery Stenosis

Impact of intravascular ultrasound guidance on directional coronary atherectomy

Use of Intravascular Ultrasound in Clinical Trials

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